Acute Inflammatory Edema: A Frequently Overlooked Case of Pseudocellulitis

Pseudocellulitis is a non-necrotizing inflammation of the dermis and hypodermis with a non-infectious etiology. One of the variants of pseudocellulitis is acute inflammatory edema (AIE), characterized by bilateral, erythematous, and edematous plaques, often found in critically ill patients. AIE is a rarely reported and frequently overlooked case of pseudocellulitis. Therefore, it needs to be differentiated from classic cellulitis, which has different management and prognosis. This case report aimed to present a case of AIE in a critically ill patient. A 71-year-old woman was admitted to intensive care with reddish swelling on four extremities. She was suffering from sepsis caused by pneumonia, congestive heart failure, tubulointerstitial disease, and hypoalbuminemia. A physical examination showed bilateral erythematous and edematous plaques that palpably felt warm. ALT-70 score was 4, indicating not likely true cellulitis. The patient was diagnosed with AIE and treated with a compression bandage, diuretics, and medications for underlying diseases. The lesions improved significantly on the second day of evaluation; unfortunately, respiratory failure caused the patient's death. Critically ill patients may have AIE misdiagnosed as cellulitis. Therefore, clinicians need to be well-versed in pseudocellulitis, especially AIE, to improve patient outcomes.